Sara Rai (https://en.wikipedia.org/wiki/Sara_Rai) is a prolific writer, editor of anthologies, and translator of modern Hindi and Urdu fiction. Her stature is not a mathematical function of her great lineage (granddaughter of Munshi Premchand) but the outcome of her soul-searching literary voyages in dignified solitude, unmindful of awards and accolades including the prized Coburg Rückert Prize.
Left mesmerized by her poignantly reflective essay “You will be the Katherine Mansfield of Hindi”, I was keen to establish contact with this maverick thought leader who seems to have connected several dots of geometry-defying lines and curves through her soulful writings. She graciously obliged and paved the way for a heartfelt conversation.
Excerpts from the Q & A...
How were your growing-up years? Who were your favourite writers as a young girl?
I was born in Allahabad and that is where I spent my childhood and teenage years. We lived in one of the colonial bungalows that Allahabad used to be known for. The pace of life was slow, and there was plenty of time to observe the trees and the birds. We had a limited interaction with the town since the bungalows were far apart even from the neighbours. There were a lot of books in the house, quite a few in English, Hindi and Urdu and some in Bangla. I read Enid Blyton as a young child of seven or eight but my curiosity, especially in my teenage years, soon began to extend to other books in the house, some of which I read without understanding them. I remember reading the Sartre trilogy, The Age of Reason, Reprieve and Iron in the Soul at the age of thirteen or fourteen with no idea of what was being said. I was attracted to books and a little later I enjoyed reading the Russians…Dostoevsky, Tolstoy, Chekhov, Turgenev. I could relate easily to them. There were others: Katherine Mansfield, Francoise Sagan, the Bronte sisters, Dickens, Thomas Hardy, George Eliot, Herman Hesse, Maupassant, Kafka, who was a huge favourite in my college years. There were a lot of books in the house and since many of my relatives wrote something or the other, I was born, so to speak, into a life of literature.
How was student life at St. Mary's, Allahabad? What were your favourite subjects? Any role models?
Life at St. Mary’s was not very different from other convent schools in the sixties. It was a Roman Catholic institution and most of the nuns who taught us were Germans from Bavaria. They enforced strict discipline and there was pin drop silence in all the classrooms and corridors when classes were on. It was more or less a rote education and I now see that in the mechanical exercise of memorizing the lessons, a sort of mental blindness was created in the students, which was quite an obstacle to education. In Math, the teacher solved the problems and wrote them on the blackboard from where we were supposed to copy them neatly in our exercise books. But English was taught very correctly with an emphasis on enunciation, on where the stress should fall in particular words and so on. We were not allowed to speak in Hindi during school hours and if caught doing so, you were supposed to pay a fine, though I didn’t hear of anyone actually doing so. We spoke in Hindi very often, especially during the lunch break. That this supposed ban on speaking Hindi was humiliating occurred to me only later. But it must have helped in learning English. I was fond of literature and art, though art as it was taught was again subject to rules that may have actually destroyed any artistic inclinations. But I did dabble in it a little later and made a few paintings of my own, most of which mercifully have now been lost. There were no particular role models for me at school.
Were there any extended family gatherings during your formative years? Did the interaction at such times shape your literary ambition in any way, or the choice of vocation?
My uncle Amrit Rai lived right across the road from us, so there was constant interaction between us. In the summers we’d go to Ranikhet together and spend a couple of months there. It was easy to let bungalows in the hills in those days. In the family gatherings conversations often focused on language but it was all very informal. There was quite a lot of joking and chatter. My uncle was rather gregarious, just as my father was quiet, introverted and, not that he needed to, led an almost ascetic life. I remember my father telling me about the Tolstoy story “How much land does a man need?” and the story left its impact on me when I read it. These are things that shape your sensibility. In family gatherings if a puzzling word cropped up in the conversations, dictionaries were immediately brought out. There was a curiosity to find out the origins, the root, particularly of Urdu words. Of course, this was a sort of linguistic training. There was never any doubt in my mind that I wanted to write stories of my own, though it took me a long time to get started.
Tell us more about your parents and their published writing, likes and dislikes.
My mother and her sister, my aunt wrote their stories first in Urdu script which they were used to writing and later transcribed the stories into Hindi, for there was a greater ease and reach of publication in Hindi. Most of their stories were published in the literary magazine Kahani, edited by my father Sripat Rai, or Kalpana, which were the reputed journals of the time. The editorials that my father wrote for Kahani as Kahani ki Baat were later published as a book with the same title by Saraswati Press. The book is now out of print. I recently put together my mother’s and aunt’s stories as a collection with the title Mahalsara ka Ek Khel aur Anya Kahaniyan by Moghal Mahmood and Zahra Rai, published by Vani Prakashan.
My father was as much a painter as he was an editor and publisher. For about twenty years of his life, he painted fairly obsessively and also held solo exhibitions. Some of his paintings were sent to the 7thTokyo Biennale in 1963. In the sporadic conversations I had with him about painting, he told me about some of the materials and techniques that went into making a painting. While talking of other painters, he hinted that his own preference was for impasto in which undiluted paint is applied with a palette knife so thickly onto the canvas that it stands out above the surface of the painting, causing light to be reflected in new ways. Because he had spent a fair amount of time in Calcutta, he was a fluent speaker of Bangla and was addicted to Rabindra Sangeet. He was present at the funeral of Tagore and the great outpouring of grief left a lasting impression on him. He would often speak of it.
Although your dad cited the example of Katherine Mansfield, the context of Hindi was not lost on him. So, in a way, he was consistent with his insistence that you should write in your mother tongue.
Yes. My father was fluent in several languages, but when it came to writing fiction, he thought one could best express oneself in the mother tongue, and he wanted me to write in Hindi. My relationship with language has not been straightforward. Since I lived in U.P., at home I spoke only in Hindi, but I heard Awadhi, Bhojpuri, Bangla being spoken. I constantly tuned in to the polished Urdu diction of my grandmother but did most of my reading in English. Given this backdrop, I could never have been monolingual. I have discussed the process of struggle, the groping and seeking that has gone into my experience of writing fiction in the “Katherine Mansfield” essay that has recently appeared with the title I originally wrote it under - “On Not Writing”- in The Book of Indian Essays – Two Hundred Years of English Prose edited by Arvind Krishna Mehrotra, published by Black Kite/Hachette.
How was the experience of helping your dad with the Kahani journal? Did the thought ever occur to you, of taking over the editorship and keeping the journal alive and kicking?
Helping my father sift through the piles of stories that arrived to be considered for publication in Kahani was exciting but also arduous. In my English medium school, I had studied only elementary Hindi and most of my reading had been done in English. So, this was really when I actually started reading Hindi fiction. My father published Kahani entirely on his own. He did not want the journal to carry advertisements nor was there money from any other source. He published it purely for the love of it, with a view to shaping contemporary Hindi literature and he did achieve this purpose. I was quite young then, barely out of college. There was no question of taking over the editorship. Apart from being young, I did not have the competence or the experience for the job.
How was the experience of the Charles Wallace Residency program?
I did go to Norwich, to the University of East Anglia, on a Charles Wallace Residency program for translation in 2003. I had taken along the short stories of Vinod Kumar Shukla, a writer whom I have long admired, and planned to translate the stories while I was there. I didn’t, as it turned out. I started writing my own novel and I wrote the first three chapters in English. It was the usual seesawing between the two languages that has been with me for a long time. I abandoned these chapters later and wrote the whole thing in Hindi. It was many years later, last year, in fact, that Arvind Krishna Mehrotra and I together translated the stories of Vinod Kumar Shukla and they were published by Harper Collins with the title Blue is Like Blue.
For someone who is equally at home in Hindi, Urdu, and English, is the economy of English still your best friend for articulation and first-draft expression?
I have said this before, but my relationship with language has been complex. Ideas don’t come in a particular language but may be a series of visual images or emotional responses to situations or scenes, when your mind suddenly lights up, something that I think of as ‘organic moments’ that later get shaped into a story. Often it is the atmosphere and the setting of the story that determines the language it is written in. Whichever language I choose to write in, the other languages that I am familiar with are simultaneously present in my mind, influencing the tone of the story and its texture. I don’t really make first drafts. Usually, it is the only draft and I keep working on the same draft till I feel I have got it right. I have found though, that English comes to me more easily when I am writing a critical or review essay and about the process of writing itself, whereas fiction comes more naturally in Hindi or Hindustani.
Your initial struggles to find your feet as a writer may have held you back, longer than you would have liked - but those very struggles in turn made you the writer you are. Is that right?
The process of writing begins much before you have put anything down on the page. The impressions that eventually mutate into fiction get embedded in the memory while life is being lived when one is not thinking of a story at all. Those impressions are only remembered later when one is actually doing the writing. Writing is a constant struggle in all sorts of ways, whenever you start writing, late or early. The struggle each writer faces while starting out on a narrative or a poem can only be described as a feeling of free fall into an abyss. There is nothing around for you to hold on to, except a scrap of an idea or image that may have come to you in one of the ‘organic moments’ that I have mentioned earlier. You have to dredge something up from nothing and this is the hardest thing to do, to give coherence to what is really only a jumble of images, sounds, and broken thoughts. I have always found that the story takes shape on the page. If you try to think it up from before, it usually fails. Once you begin writing, one word follows another and may result in an image or a metaphor, and eventually a story. Or it may not. And then you are having a bad day, which is not infrequent either. It is a very mysterious business, rather difficult to understand.
Which among your published writings is closer to your heart - forgive the cliche the question houses, but I wish to know which of those writings (your debut story Lucky Horace included) came out exactly as you wished them to?
As I said earlier, there is little preconceived idea about what the story you are writing will become. The whole process of writing is a sort of accident. So, I cannot say that some story came out exactly as I wished it to. But in the writing of it, there comes a point when you feel that the story has come to a close, and you stop. And it is only then that you assess what you have written. Each story works out differently, but if I had to choose, I would say that my story ‘Bhulbhulaiyaan’ (The Labyrinth) was one where all the elements fell together, the setting, the character, the voice, the tone, the texture. I wrote ‘Lucky Horace’ when I was eight years old and it was more like a discovery that I could write rather than a real story.
Is the evocative imagery of your stories rooted in your childhood days of freewheeling observation? I found the pressure cooker whistle in a couple of stories.
Memory plays a huge role in writing fiction. The setting of a story and the ground on which it stands needs a physical location. To describe a scene in detail, those details have to be familiar to the writer and that is where memory comes in. You don’t quite know which Sunday afternoon, which bird singing on the pine tree, which visitor who dropped by, or which sentence, forgotten till now, spoken by an acquaintance will suddenly surface when you are writing. The routine or the commonplace is often what one’s days are composed of and it is these ‘dull’ days (on which you may notice the whistle of the pressure cooker) that offer the space for thought and yield experiences that stay with you and become stories.
Between writing and translations, would you prefer one over another given a choice - or do both mingle in peaceful coexistence like how English, Hindi and Urdu do for you?
It is not really a question of preferring writing over translation, or the other way round. Both writing and translation come from the same place, which is the ground, on which you stand, of being a writer. The two activities of writing and translation belong together and keep developing and expanding each other’s range. Where the repository of words that you possess is helpful in the process of translating, the activity of translation involves an intimate engagement with a text that is not your own, but which in the process of translation becomes your own. It enriches your storehouse of words and helps you to arrive at new ways of tackling your material.
PS: In the course of writing this blogpost, I also discovered 'Lamhi' - a quarterly published and edited by Vijay Rai who mailed me special editions of Lamhi featuring Sripat Rai, Shivmurti, and Dr. Gyan Chaturvedi. He also helped me secure a copy of Amrit Rai's priceless biography of Munshiji titled "Premchand: Kalam ka Sipahi".
Vijayji, thanks a ton for you prompt help, and I shall soon write about Lamhi and its contents in a separate blogspot. For now, I can only profusely agree with Late Doodhnath Singhji's earthy compliment "विजय ई बतावा कि लमही पत्रिका का नाम तोहरे जेहन में कैसे आयल | आज तक कोई और ई नाम से पत्रिका काहे नहीं निकाललस"
'Lamhi' is one of the best tributes to Munshiji in contemporary times who is as relevant today as he was decades back. The more you read him, the more you miss him:
The other day, I got the shock of my life in the most unusual of circumstances that are best left undescribed, given they are truly indescribable. But having absorbed the shock like a precious life lesson, I have moved on without disturbing my homegrown poise and self-imposed equanimity.
Thanks to the sheer gravity of the stomach-churning experience, I now know better:
...that familial roots have little meaning if familial fruits hang on genetically modified trees of their choice
...that it is futile to supply a carefully curated set of introspective questions if the maverick in question already has all the answers
...that it is sheer madness to try and wake up those who pretend to be asleep, regardless of whether they are kids, adolescents, young Turks, or old people
....that you have no right to subject your own folks to torturous sessions of mandatory confinement for the sake of folks who are no longer your 'known'
...that using a comma where a full stop is urgently called for can cause blunders more ghastly than what errors of punctuation imply
Before I sign-off for good, here's a humble piece of heartfelt advice to the learned souls who inadvertantly caused me great anguish:
No disaster is as lethal as the one concerning Health. If and when possible, get your home water-proofed. Damp walls are the harbingers of disease and disorder. And embrace Pranayama with open arms. May the power of Anulom Vilom and Kapalbhati bless you with everlasting health, peace, and well being.
Most important, in every conversation, he refrains from being prescriptive about his ways. Instead, he encourages you to drive your own vehicles of inquiry aimed at touching the depths, not allowing you to be swayed by lengths and widths in settling for convenient conclusions.
I hardly enjoyed my early schooling years as they were only about book learning, not about the experiential leaning that I craved for. I was the inquisitive type, ever loaded with a flurry of fundamental questions, but we were invariably encouraged to accept facts, never to question them. As was the general format the world over, superficial and surface-level learning was the norm. ‘This is the way it is, you can’t go beyond’ was the implied warning accompanying each lesson. Consequently, I struggled to stay put, somehow balancing my tryst with books with a little bit of play. Thankfully, I was blessed with an outstanding physics teacher Mr. Ganesh Prabhu during my transition to high school. This maverick virtually drilled a hole in my soul. Today I realise he actually taught me design thinking besides introducing me to the fascinating depths of astrophysics. I was so immersed in the subject that I even decided to pursue astrophysics as a career. To multiply my delight, I was also introduced to a couple of gems: Mr. Vag Shenoy who showed me the marvels of mathematics and Mr. Subramaniam who taught me the art and science of the English language. Under the tutelage of this dynamic trio, I was undergoing the most transformative years of my life, the foundation stone of my life.
Was this the turning point in your academic voyage?
Absolutely. It was a game changer. These Gurus scared the living daylights out of me in a very positive way. Today, I can say with great pride that my role models of the time were not the usual known greats like Mahatma Gandhi. They were Prabhu sir, Vag sir and Subramaniam sir. I still remember Vag sir’s trigonometry class. He enters the class, walks up to the blackboard, draws a right angled triangle, and writes a/b. He only says, ‘this is tan theta’ and leaves the class, with us staring at the blackboard in absolute wonderment. The next day, he proceeds to the next step in similar fashion. Years later, I realised this was the best way to approach any problem. The more you ponder over the ‘chakarvyuh’ of any challenge, the more you are likely to find the way in and out of it.
It soon dawned on me that my new-found fascination with learning was more to do with the teacher, rather than the subject. It was about the way the subject was taught, which had reasoning embedded into the learning. I could not see anything beyond physics and mathematics. I loved trigonometry and calculus and gradually dabbled into the intricacies of quantum physics. Locking horns with complex IIT problems of astrophysics and mathematics ignited a different spark in my brain. It may seem odd, given my chosen profession, but biology did not interest me one bit. This subject was a bible of facts, and you were not supposed to question facts; you were instructed to accept them. And I was inherently programmed to defy this diktat.
Yes, it was not love, it was an obsession. Thanks to both subjects, I was brought face to face with two great philosophies in science: one was the Einsteinian theory that urged you to imagine without an hypothesis, and the other was the Newtonian doctrine, which instructed you to experiment towards building a hypothesis. I learnt both with an open mind. Thanks to the unique methods of Vag sir, we learnt that problem solving becomes most enjoyable when it seems impossible. He stimulated our thinking by offering minimal help. He never gave the solution on a platter. He made us think through the problem in solitude. He showed us any given step only when we had given up, not earlier. This method of teaching and learning became ingrained in my life.
Plenty, but I will share one particular instance from the fag end of my high school learning, when we were almost ready to take the plunge into higher education. Vag sir used to take a tutorial class for a small group of students which we fondly called the Vag ashram. He always admonished us for our laid-back approach to life and work, which he believed rendered us completely useless. So, one fine day, after drawing on the board a complex engineering problem that he had plucked from the weirdest corners of IIT questionnaires, he threw a challenge at us in inimitable style: ‘The solution to this problem has 10 steps, I want you to get the first step right, you have one hour, and your time starts now.’
In less than an hour, I and one of my classmates Shailesh solved the entire complex algorithm. When Vag sir had a look at our copies, he immediately asked us to leave the class and continued addressing the rest of the class. Now, we both were not at all the serious students you would normally expect in a math class. We sat under a tree wondering whether we did the right thing in attempting the problem. However, being the crazy types ourselves, we knew we were right and Vag sir had only granted us a special place in his heart by shooing us out. He was a minimalist, a man who rarely ever smiled, leave alone attempting a casual conversation with anyone. Vag sir had asked us to leave as he believed we didn’t belong to that group anymore. The others might have thought we both had committed a blunder they were very lucky to escape.
Did this turning point improve your grades in school and college?
During the early years, I was statistically an outlier, an average student, but under the wings of these masters, things seemed to accommodate and fall in place around me. All of a sudden, scoring cent percent marks became a cakewalk although I was never target-driven, nor did I ever aspire to top the class or anything like that. Thanks to my mother’s efforts, I was able to balance spiritualism and purpose, never linking effort with a goal or target. I have always believed the pursuit for perfection should be effortless. Results should only be a by-product of your wilful deep dive into the chosen subject. There’s hardly any point in subjecting yourself to textbook learning ordeals with no love for the subject.
When and how did medicine creep into your scheme of things?
Like I said before, biology didn’t interest me, so medicine was nowhere on my priority list of aspirations which had only four tick marks: astrophysics, mathematics, hotel management and bike racing. The first two were obvious; the last two were based on my perception of preoccupations linked with contentment. So many around me were pursuing hotel management and they seemed really happy, so I presumed this was something fun and fulfilling. Biking was one of my hobbies so I had decided that if nothing else worked, I would make it my career.
But as things would have it, I accidentally did very well in the biology exam and my mom was thoroughly convinced that I should pursue medicine. She strongly felt only medicine would offer me the god sent opportunity to heal people and touch lives, and the magic of science that I was sold on will work wonders in biology. I was not convinced, but she told me I will meet someone soon who will show me the way. Reluctantly, I decided to give in to her insistence.
Now, when it came to studying medicine, both me and my mom unanimously agreed that I should study in Manipal. However, when my marks fetched me a merit seat in a Belgaum college, I was thoroughly disappointed. I had not even heard of the place before. Mom told me not to worry. An ardent devotee of Shirdi Sai baba, she believed the written parayana of Sai Charitra would fetch me an immediate transfer within a week’s time. But in the rush to return to Mangalore, she forgot the Sai Charitra on the admission counter of the Belgaum college, the last few pages left unfilled. So, this time round, she told me to begin my studies in Belgaum and wait for the first opportunity to secure a transfer.
Can you share a few pages of your Belgaum diaries?
Throughout my tenure at Belgaum, I was known to
be an exceptionally unruly student.
Invariably found lurking in the unlikeliest of corners, I regularly
bunked classes and partied with friends on untimely vacations and getaways.
Much to the dismay of my professors and classmates, I cleared all my exams,
managing to study for a week or two during which time I was nowhere to be
found. In a nutshell, I was in my own world, living by my own rules.
And yet, certain influences came to stay with me for life. Prof. Humbarwadi was my first mentor and guide in Belgaum. I spent hours with him on his pet preoccupation of dissecting the voice box, marveling at its enigma and exceptionalism. It then seemed a wayward exploration, unaware that I was of the ‘grand plan’ that was to unfold in due course. I call it the premonition of destiny. Today, when I connect the dots, my ongoing work on voice prosthesis innovation is automatically put into perspective. You connect the dots when you turn back, not when you look forward. You simply need to keep creating the dots as you move forward. At some point, it all begins to make sense.
The architect of the other turning point, the proverbial U-turn of my medical vocation, was Dr. Arvind Desai. He was known to be a rather vintage maverick, a hard nut to crack. I proactively secured posting under him, trading mine with a friend who had to attend a wedding, who was more than happy to escape the Desai ‘trial’. My logic was simple, who could be worse than me?
Dr. Desai was the best thing that happened to me in Belgaum. He had an outstanding clinical acumen, and he treated patients like family. Rather than applying textbook principles on a patient, he created a textbook out of the patient, such was his mastery as a visionary practitioner. I used to get up at 3 a.m. only to observe him at work. He would open the Harrison’s Principles of Internal Medicine and literally pre-empt the patient symptoms, ensuing interventions and likely outcomes – right from the point of admission to the point of discharge, like how an astrologer reveals what stars foretell. My admiration for him turned into worship within no time.
I still recollect a difficult case of an ICU patient, a pregnant lady who had attempted suicide. Dr. Desai narrated the entire regimen in inimitable style – ‘These are the parameters, this is the ventilator setting, this would be the intervention, she would be out of the ICU on the 5th day, she would be discharged on the 7th day’. It was like a true story unfolding before my eyes. Everything happened just as he had predicted. On the day of discharge, I came to know that he had even settled the bill on the poor lady’s behalf, sacrificing half of his salary. I was speechless, witnessing humanism in all its glory, after having suffered a truckload of regular experiences rooted in nepotism and fascism. When I went to pay my compliments on an impulse, he shooed me away, urging me to get back to work rather than wasting time in thanksgiving, which he reckoned was a useless endeavour.
On the last day of my posting, I touched his feet. It was only then that he told me, “Vishal, 20 years back, I worked at your hospital in Mangalore. I didn’t tell you before as I wished to protect you from bias of any sort.” Dr. Desai, during his student days, had interned at a Mangalore hospital owned by my family. I now fathomed why I instinctively felt a deep connect with him. I could sense the preordained flavour of the association. The world is indeed a small place and we are all connected in ways not known to us.
What was the trajectory post Belgaum?
When I was ready to leave Belgaum, I aspired to become a neuro physician, not a surgeon. However, I almost instinctively chose oncology for my post-graduation, without any known trigger whatsoever to explain the choice. In the library, my eyes invariably fixated on a chapter on throat cancer every time I opened my book, almost as if this chapter held a series of decisive conversations with me, not the other way round.
I made Head and Neck cancer surgery my choice for specialization, and even ‘decided’ on the institution to pursue it: the Tata Memorial Hospital in Bombay (although I had an assured seat in a Bangalore institution). All of this happened without any rational explanation to ‘justify’ my choice. I went to Tata Memorial Hospital to secure my internship even before my results were announced.
Meanwhile, I was awarded a gold medal in my PG. One other gentleman who had also won the gold medal mockingly complained to me: “Vishal, you have devalued Gold. Almost everyone to whom I convey the good news says: no big deal, if someone like Vishal with his relaxed lifestyle can get it, anyone can fetch it” I relished this situation as it took away the awe linked with such feats. The hype around academic achievements needlessly creates a fear psychosis among most learners which is not how it should be. Education should trigger jubilation, not trepidation.
I relished the three-year Tata experience end to end. 13 hours of daily duty left me no room for personal life, but I had no reason to complain. Time flew like never before under the guiding light of selfless veterans like Dr. Pankaj Chaturvedi. His pioneering efforts aimed at cancer prevention (as also some celestial direction from up above) put me on an offbeat track: of striving to reduce the need for a hospital by working towards disease prevention, not to build another hospital for disease management.
Medical care is only a part of the holistic term health care, and it comes into play only when there is a deviation from health. A healthy society thrives on as less ailments and hospitals as possible. High time we broke the conformal barriers that disallow health care innovations to serve the larger cause of humanity.
Given your spiritual bent of mind, did you face any workplace conflict or quandary in a typical healthcare setting?
There is no conflict, there is only resolution.
Spirituality, as I see it, is an unexplored science, and God surely follows the principles of Quantum Physics. I read the Bhagwad Geeta out of sheer curiosity, an endeavour which strengthened my belief that spirituality lends you grace and gravity: the grace that lifts you upwards and the gravity that keeps you grounded. You need both to ensure progression.
Spirituality helps us see through and work around problems, not attack them in mindless fashion. Take the case of cancer. There is a
How right was Werner Heisenberg, the founding father of Quantum Mechanics, when he said, "The first gulp from the glass of natural sciences will turn you into an atheist, but at the bottom of the glass God is waiting for you.”
The ascetic spirit of India was best envisioned by Swami Vivekananda. He and Jamsetji Tata met en route a Japan to Chicago voyage when Swamiji shared his aspiration with the visionary industrialist, “What a wonderful feat it would be, if the philosophy of the east met the science of the west”. Years later, Jamsetji incepted the Indian Institute of Science (IIS), donating almost half of his personal wealth for this noble cause. Jamsetji’s letter addressed to Swami Vivekananda, which has been embossed on the IISc walls, is a towering inspiration to millions who harbour similar ambitions rooted in selflessness.
The turning points in my medical career have given me a renewed sense of purpose, and the ensuing objectivity has helped me appreciate the play of life and death in a reassuringly spiritual light.
Your strides in AI and robotic surgery are exceptional in every sense. How did the tryst with your machine friends begin?
As medical students, we tend to equate deep learning with a state of being perpetually under the water, studying and poring over intricate concepts all the time. This perception essentially spells the disconnect between med tech and medicine. Bridging this gap is an acute need, it is no longer an option.
Every specialty today is moving away from organ ablation towards organ preservation. In fact, within this fundamental departure is housed another paradigm shift: of achieving organ preservation even through surgical means, not just through non-surgical means like radiation. But unless organ preservation reinstates organ functionality, any restoration will be rendered deficient if not fruitless, given that the patient will be ruthlessly deprived of quality of life. My belief in the power of med tech stems from this acute need to ensure quality of life for my patients, which is as much about restoring their capabilities to earn livelihood and social respect as about saving their lives and vital organs.
Today, I do a lot of robotic surgeries but ten years back, I had not even imagined this big leap forward. Back then, robots were not in my scheme of things as I was happy with my results and dreaded the possibility of any disruption affecting my efficiency and consistency. However, my perspective changed the moment I visited the Robotic Innovation Center in Korea as part of a training program. I got a great glimpse of what was to unfold in the next ten years.
After I came back, I set about unlearning a lot that I had learnt in the last decade. Unlearning is the key differentiator for innovation and insight. This unlearning has helped me fathom the essence and credence of our robot friends.
I always say a surgeon has ten most important instruments at his or her disposal; these are not any fancy devices of plastic or metal, but a surgeon’s ten fingers, each blessed with unique clinical capabilities. Now, surgeons have small eyes and big hands, while the robot has small hands and big eyes. That’s the game changer any surgeon would relish: to probe deep into areas with enhanced vision and precision. Technology has made the representation of reality way more interesting than the reality itself. No wonder, robots take site location and visualization and human error mitigation to a whole new level.
You have gainfully used interventional radiology in conjunction with robotic surgery.
I would cite one classic example of a tongue cancer patient of mine. He had completed chemotherapy and the tumour had recurred in a span of four months. In conventional surgery, when you remove the base tongue, you may have to remove the entire tongue and even the voice box, which massively impacts the patient’s quality of life. I was intent on helping my patient escape this unpleasant eventuality.
Interventional radiology helped me block the posterior branch of the lingual artery (principal artery supplying blood to the oral floor and tongue), thereby blocking the base tongue. This way, we could achieve tongue resurrection in a manner akin to removing the entire ground floor without removing the first floor. This was unthinkable without interventional radiology and robotic surgery.
This potent combination helps the surgeon breathe easy in every respect, given the submillimetre precision in mapping, analysing, and holding on to the tumour at the exact point in the given surgical step, thereby even allowing the surgeon to take a break midway, without losing precision as also eliminating the torrential bleeding that otherwise accompanies organ resurrection in such surgeries.
This is what I call the era of fusion medicine where the radiologist enters into the OT and perform a cardiac surgery, and he is rechristened as the interventional radiologist. On the other hand, a surgeon has the CT scanner inside the OT, and he becomes the navigational surgeon. The med tech possibilities are immense, the merger between radiology and robotic surgery is only a part of fusion medicine. Going forward, machines won’t replace doctors as is being furiously speculated; instead, they will assist doctors to augment and accelerate human healing. The medical fraternity is at a juncture today where acceptance of this fourth wave is not an option anymore.
How will this buy-in come about?
The fundamentals of this buy-in lie in purposeful medical education, which will happen only through a systematic and consistent collaboration between academia and the industry to create powerful synergies. We need to develop a consortium to challenge status quos; we need to move from eminence-based medicine to evidence-based medicine.
today is at 4.2 while health is still moving from 1.2 to 2.2, lagging almost
two generations behind. In the next decade, health will be able to keep pace
with industry only if it embraces AI, robotics and a host of other technologies
including digital therapies, IoTs, ultrafast scanners, wearable devices, big
data, blockchain and nano health. The real charm of these technologies is their
cross-talk; they form a potent and purposeful ecosystem; they don’t work in
isolation. The coming generation of robotic
surgery will be driven by retractors, nano bots, fusion of drones with robots,
extended reality devices, and super conscious robots.
Consequently, health will become wellness-driven, not disease-driven. The myopic view that healthcare is only about disease management will disappear into thin air. To put it in simpler terms, Paracetamol 650 mg will no longer be universally administered.
And how soon do you see the transformation happening?
Very soon. Earlier, we used to define changes as generation gaps, today we define them as version gaps. That explains the shrinkage of bench to bedside cycles: from several years to a matter of few months and days. And it is such a good thing, given the need for accuracy and consistency in medical interventions.
Our greatest competitors are in fact our strongest collaborators. What better time than now to harness the power of collaboration to its fullest, thereby expanding our outreach to masses for achieving far-reaching, measurable, cost-effective, and sustainable social outcomes.
Is a cancer moonshoot initiative possible in India?
The groundshot initiative has already begun in India, and no better place than India to launch a moon shot initiative as well. Aided by technology, focused studies like cancer genomics will provide us with even richer and actionable insights for precision medicine. We only need to move away from our pet preoccupation of singing glories of our rich heritage without fostering and experimenting with original ideas. How long are we going to remain constrained copycats of the West?
It is only when we dive deep into the living waters of disruptive innovation, powering ambition with purpose, that wealth and value creation will happen at the intersection of socialism and capitalism, giving birth to conscious capitalism which will ensure economies of scale. If we are proud to achieve a Formula One pit stop in 1.82 seconds, shouldn’t we aspire to save a life in lesser time and with better speed. I think we should, and we can, provided we create the doors of possibilities, not merely open the doors of opportunities.
Rao’s spirituality and mystical experiences comprise an epic subject that merits comprehensive chronicles. Even the preface to it has been excluded from the purview of this thought
piece as it is only for a readership attuned to grasping the depth and
gravity of the subject matter; individuals who are blessed with the ability to suspend
judgment without harming the cocoon of scientific temper; those who can protect
the fabric of intuitive discoveries from the brute force of perfunctory intellect;
those select few, to quote Dr. Rao, who “strive to be spiritually intellectual,
not intellectually spiritual.”